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Petersen AS, Kristensen DM, Westgate CSJ, Folkmann-Hansen T, Lund N, Barloese M, Søborg MLK, Snoer A, Johannsen TH, Frederiksen H, Juul A, Jensen RH. Compensated Hypogonadism Identified in Males with Cluster Headache: A Prospective Case-Controlled Study. Ann Neurol 2024; 95:1149-1161. [PMID: 38558306 DOI: 10.1002/ana.26906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Androgens have been hypothesized to be involved in the pathophysiology of cluster headache due to the male predominance, but whether androgens are altered in patients with cluster headache remains unclear. METHODS We performed a prospective, case-controlled study in adult males with cluster headache. Sera were measured for hormones including testosterone, luteinizing hormone (LH), and sex hormone-binding globulin in 60 participants with episodic cluster headache (during a bout and in remission), 60 participants with chronic cluster headache, and 60 age- and sex-matched healthy controls. Free testosterone (fT) was calculated according to the Vermeulen equation. Shared genetic risk variants were assessed between cluster headache and testosterone concentrations. RESULTS The mean fT/LH ratio was reduced by 35% (95% confidence interval [CI]: 21%-47%, p < 0.0001) in patients with chronic cluster headache and by 24% (95% CI: 9%-37%, p = 0.004) in patients with episodic cluster headache compared to controls after adjusting for age, sleep duration, and use of acute medication. Androgen concentrations did not differ between bouts and remissions. Furthermore, a shared genetic risk allele, rs112572874 (located in the intron of the microtubule associated protein tau (MAPT) gene on chromosome 17), between fT and cluster headache was identified. INTERPRETATION Our results demonstrate that the male endocrine system is altered in patients with cluster headache to a state of compensated hypogonadism, and this is not an epiphenomenon associated with sleep or the use of acute medication. Together with the identified shared genetic risk allele, this may suggest a pathophysiological link between cluster headache and fT. ANN NEUROL 2024;95:1149-1161.
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Affiliation(s)
- Anja S Petersen
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - David M Kristensen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
- Department of Science and Environment, Roskilde University, Denmark
| | - Connar S J Westgate
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Thomas Folkmann-Hansen
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
- Novo Nordisk Foundation Center for Protein Research, Copenhagen University, Copenhagen, Denmark
| | - Nunu Lund
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Mads Barloese
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark
| | - Marie-Louise K Søborg
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Agneta Snoer
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Trine H Johannsen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rigmor H Jensen
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Rajandram R, Koong JK, Quek KF, Lee EG, Razack AHA, Kuppusamy S. Ethnic differences in serum testosterone concentration among Malay, Chinese and Indian men: A cross-sectional study. Clin Endocrinol (Oxf) 2022; 97:303-309. [PMID: 35107834 DOI: 10.1111/cen.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate non-urological patients with multiple comorbidities for factors contributing towards differences in testosterone concentration in multiethnic Malaysian men. DESIGN An observational study. PATIENTS Sexually active men, ≥40 years, with no known urological problems, were recruited at the phlebotomy clinic at our centre. MEASUREMENTS A brief history along with latest fasting lipid profile and plasma glucose levels were obtained. An Aging Male Symptoms questionnaire was administered; waist circumference (WC) and serum testosterone concentration were measured. STATSTICAL ANALYSIS Analysis of testosterone concentration between Malay, Indian and Chinese men was performed. Statistical tests such as analysis of variance, χ2 test, univariate and multivariable regression were performed. Any p < .05 was noted as statistically significant. RESULTS Among the 604 participants analysed, mean testosterone concentration was significantly lower in Malays (15.1 ± 5.9 nmol/L) compared to the Chinese (17.0 ± 5.9 nmol/L) and Indian (16.1 ± 6.5 nmol/L) participants. The mean WC was also found to be higher among the Malays (96.1 ± 10.9 cm) compared to Chinese (92.6 ± 9.6 cm) and Indians (95.6 ± 9.9 cm). Testosterone concentration tended to be lower with higher age, but this was not statistically significant (p > .05). In the multivariable analysis only Malay ethnicity, WC ≥ 90 cm and low high-density lipoprotein (HDL) were associated with lower testosterone concentration. CONCLUSION In this study, Malaysian men of Malay origin had lower testosterone concentration compared with Indian and Chinese men. WC and low HDL were also associated with lower testosterone concentrations.
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Affiliation(s)
- Retnagowri Rajandram
- Department of Surgery, Faculty of Medicine, University of Malaya, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jun K Koong
- Department of Surgery, Faculty of Medicine, University of Malaya, Universiti Malaya, Kuala Lumpur, Malaysia
- Division of Urology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Kia F Quek
- Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Eng G Lee
- Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Azad H A Razack
- Department of Surgery, Faculty of Medicine, University of Malaya, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shanggar Kuppusamy
- Department of Surgery, Faculty of Medicine, University of Malaya, Universiti Malaya, Kuala Lumpur, Malaysia
- Division of Urology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
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Kramer BL. The molecularization of race in testosterone research. BIOSOCIETIES 2020. [DOI: 10.1057/s41292-020-00200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Adiposity and mortality in older Chinese: an 11-year follow-up of the Guangzhou Biobank Cohort Study. Sci Rep 2020; 10:1924. [PMID: 32024868 PMCID: PMC7002501 DOI: 10.1038/s41598-020-58633-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
Previous studies on Chinese showed mixed results describing the relationship between obesity and mortality. The optimum levels of body mass index (BMI) and waist circumference (WC) are inconsistent. In the Guangzhou Biobank Cohort Study, after excluding ever smokers and those with poor health, 19,405 Chinese (50+ years) recruited from 2003 to 2008 were followed-up until 2017. During an average follow-up of 11.5 (standard deviation = 2.3) years, 1,757 deaths were recorded. All-cause mortality showed a J-shaped association with BMI, with the lowest mortality risks at 22.5 kg/m2 for both men and women. In those with BMI ≥ 22.5 kg/m2, an increase of 5 kg/m2 was associated with 29% higher all-cause mortality (hazard ratio (HR) = 1.29, 95% confidence interval (CI) 1.15–1.46), 30% higher cancer mortality (1.30, 95% CI 1.08–1.57), and 37% higher cardiovascular disease (CVD) mortality (1.37, 95% CI 1.13–1.67) after adjustment for potential confounders. In this first cohort study in one of the most economically developed cities in China, the lowest all-cause mortality was observed for a BMI of 22.5 kg/m2 in all participants, and a WC of 78 cm in men and 72 cm in women.
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Wu WH, Yuan P, Zhang SJ, Jiang X, Wu C, Li Y, Liu SF, Liu QQ, Li JH, Pudasaini B, Hu QH, Dupuis J, Jing ZC. Impact of Pituitary-Gonadal Axis Hormones on Pulmonary Arterial Hypertension in Men. Hypertension 2018; 72:151-158. [PMID: 29712743 DOI: 10.1161/hypertensionaha.118.10963] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/19/2018] [Accepted: 04/03/2018] [Indexed: 11/16/2022]
Abstract
The association of sex hormone (estradiol, testosterone, and progesterone) with cardiopulmonary disease has already attracted great attention, especially in pulmonary arterial hypertension (PAH). However, the impact of sex hormones and their pituitary stimulators (follicle-stimulating hormone and luteinizing hormone) on PAH in men remains unclear. We conducted a prospective cohort study recruiting 95 patients with idiopathic PAH from 2008 to 2014 and following up for a median of 65 months for death. Compared with control, abnormal plasma levels of sex hormones were more common in patients with PAH. Higher estradiol and estradiol/testosterone levels were associated with risk of PAH diagnosis (odds ratio per ln estradiol, 3.55; P<0.001; odds ratio per ln estradiol/testosterone, 4.30; P<0.001), whereas higher testosterone and progesterone were associated with a reduced risk (odds ratio per ln testosterone, 0.48; P=0.003; odds ratio per ln progesterone, 0.09; P<0.001). Fifty patients died during follow-up. Men with higher estradiol had increased mortality (hazard ratio per ln estradiol, 2.02; P=0.007), even after adjustment for baseline characteristics and PAH treatment. According to receiver operating characteristic analysis, patients with PAH with higher estradiol level (≥145.55 pmol/L) had worse 5-year survival rate compared with those with lower estradiol (38.6% versus 68.2%; log-rank test P=0.001). Therefore, our data show higher estradiol, estradiol/testosterone ratio, lower testosterone, and progesterone were associated with increased risk of PAH. Meanwhile, higher estradiol was independently associated with higher mortality in men with PAH. Further studies are needed to explain the origin of these hormonal derangements and their potential pathophysiological implications in PAH.
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Affiliation(s)
- Wen-Hui Wu
- From the Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China (W.-H.W., P.Y., S.-J.Z., Y.L., B.P.)
| | - Ping Yuan
- From the Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China (W.-H.W., P.Y., S.-J.Z., Y.L., B.P.)
| | - Si-Jin Zhang
- From the Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China (W.-H.W., P.Y., S.-J.Z., Y.L., B.P.)
| | - Xin Jiang
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing (X.J., S.-F.L., Q.-Q.L., J.-H.L., Z.-C.J.)
| | - Cheng Wu
- Department of Health Statistics, Second Military Medical University, Shanghai, China (C.W.)
| | - Yuan Li
- From the Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China (W.-H.W., P.Y., S.-J.Z., Y.L., B.P.)
| | - Shao-Fei Liu
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing (X.J., S.-F.L., Q.-Q.L., J.-H.L., Z.-C.J.)
| | - Qian-Qian Liu
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing (X.J., S.-F.L., Q.-Q.L., J.-H.L., Z.-C.J.)
| | - Jing-Hui Li
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing (X.J., S.-F.L., Q.-Q.L., J.-H.L., Z.-C.J.)
| | - Bigyan Pudasaini
- From the Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China (W.-H.W., P.Y., S.-J.Z., Y.L., B.P.)
| | - Qing-Hua Hu
- Department of Pathophysiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (Q.-H.H.)
| | - Jocelyn Dupuis
- Montreal Heart Institute Research Center, Université de Montréal, Québec, Canada (J.D.)
| | - Zhi-Cheng Jing
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, and Key Laboratory of Pulmonary Vascular Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing (X.J., S.-F.L., Q.-Q.L., J.-H.L., Z.-C.J.)
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Abstract
Background Most of the androgen replacement therapies were based on serum testosterone and without measurements of total androgen activities. Whether those with low testosterone also have low levels of androgen activity is largely unknown. We hence examined the association between testosterone and androstanediol glucuronide (AG), a reliable measure of androgen activity, in a nationally representative sample of US men. Methods Cross-sectional analysis was based on 1493 men from the Third National Health and Nutrition examination Survey (NHANES III) conducted from 1988 to 1991. Serum testosterone and AG were measured by immunoassay. Kernel density was used to estimate the average density of serum AG concentrations by quartiles of testosterone. Results Testosterone was weakly and positively correlated with AG (correlation coefficient = 0.18). The kernel density estimates show that the distributions are quite similar between the quartiles of testosterone. After adjustment for age, the distributions of AG in quartiles of testosterone did not change. The correlation between testosterone and AG was stronger in men with younger age, lower body mass index, non-smoking and good self-rated health and health status. Conclusions Serum testosterone is weakly correlated with total androgen activities, and the correlation is even weaker for those with poor self-rated health. Our results suggest that measurement of total androgen activity in addition to testosterone is necessary in clinical practice, especially before administration of androgen replacement therapy.
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Affiliation(s)
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, 2nd Zhongshang Road, Guangzhou, Guangdong Province, China.
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Zhu H, Wang N, Han B, Li Q, Chen Y, Zhu C, Chen Y, Xia F, Cang Z, Lu M, Chen C, Lin D, Lu Y. Low Sex Hormone-Binding Globulin Levels Associate with Prediabetes in Chinese Men Independent of Total Testosterone. PLoS One 2016; 11:e0162004. [PMID: 27583401 PMCID: PMC5008813 DOI: 10.1371/journal.pone.0162004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/16/2016] [Indexed: 12/30/2022] Open
Abstract
Objective The association ns between prediabetes and androgens have been rarely reported, especially in Chinese men. We aimed to investigate whether androgens were associated with the prevalence of prediabetes diagnosed with new American Diabetes Association criteria in Chinese men and then to assess which androgen value was the most relevant factor. Methods A total of 2654 men (52.6±13.4 years old) were selected. Serum total testosterone (TT), sex hormone-binding globulin (SHBG) and free testosterone (FT) were measured. Covariance analysis of different androgen values were performed in age subgroups. Multinomial logistic regression was used for the association of TT, SHBG and FT with prediabetes and diabetes, as well as prediabetes in age subgroups. Results According to ADA new criteria, normoglycemia, prediabetes, and diabetes were diagnosed in 1405, 907 and 342 men, respectively. In covariance analysis, SHBG of prediabetes were found lower than that of normoglycemia but higher than that of diabetes (P <0.05). In multinomial logistic regression, serum TT and SHBG were inversely associated with prediabetes and diabetes. While, after full adjustment for age, residence area, economic status, waist circumference, metabolic factors, other two androgen values and HOMA-IR, only the associations of SHBG with prevalence of prediabetes and diabetes persisted statistically significant, especially in the elderly with prediabetes (all P for trend <0.05). Conclusions Serum androgen was inversely associated with prediabetes and diabetes in Chinese men. Low serum SHBG was the most relevant factor for prediabetes and diabetes. Whether it is an independent predictor for incident prediabetes in Chinese men needs further explorations.
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Affiliation(s)
- Hui Zhu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Bing Han
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Qin Li
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Chunfang Zhu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Yingchao Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Zhen Cang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Meng Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Dongping Lin
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- * E-mail:
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Zhao JV, Schooling CM. Endogenous androgen exposures and ischemic heart disease, a separate sample Mendelian randomization study. Int J Cardiol 2016; 222:940-945. [PMID: 27526363 DOI: 10.1016/j.ijcard.2016.07.174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evolutionary biology suggests growth and reproduction trade-off against longevity. Correspondingly estrogen supplementation failed to increase lifespan. Testosterone supplementation is widely used by older men, although regulators have warned of its cardiovascular risk. No large trial of testosterone exists. We examined how genetic determinants of up-regulation (follicle-stimulating hormone (FSH)) and down-regulation (anti-Müllerian hormone (AMH) and testicular dysgenesis syndrome (TDS)) of mainly the male reproductive system are associated with ischemic heart disease (IHD). METHODS Separate sample instrumental variable analysis with genetic instruments, i.e., Mendelian randomization, was used to obtain unconfounded estimates using large case-control studies of coronary artery disease/myocardial infarction (CAD/MI) with extensive genotyping, i.e., CARDIoGRAMplusC4D (64,374 CAD/MI cases, 130,681controls), or CARDIoGRAMplusC4D 1000 Genomes (60,801 cases, 123,504 controls). RESULTS Genetically predicted FSH was positively associated with CAD/MI (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.03 to 1.13 per mIU/mL FSH). Genetically predicted AMH and TDS were inversely associated with CAD/MI (OR 0.93, 95% CI 0.87 to 0.998 per ng/mL log AMH and OR 0.89, 95% CI 0.81 to 0.98 per log OR higher risk of TDS). CONCLUSIONS As expected from evolutionary biology, genetically predicted FSH, related to higher androgens in men and women, was positively associated with IHD, while genetically predicted AMH and TDS, related to lower androgens in men, were inversely associated with IHD. Androgens might be a modifiable causal factor underlying men's greater vulnerability to IHD, with corresponding implications for use of testosterone supplementation as well as for prevention and treatment of IHD.
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Affiliation(s)
- Jie V Zhao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; City University of New York, School of Public Health and Health Policy, New York, NY, USA.
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Ellis L, Lykins A, Hoskin A, Ratnasingam M. Putative Androgen Exposure and Sexual Orientation: Cross-Cultural Evidence Suggesting a Modified Neurohormonal Theory. J Sex Med 2015; 12:2364-77. [PMID: 26663858 DOI: 10.1111/jsm.13070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION According to neurohormonal theory, prenatal androgens are key determinants of sexual orientation. As a reputed marker for prenatal androgens, the 2D:4D finger length ratio has been used in more than a dozen studies to test the hypothesis that prenatal androgens influence sexual orientation. Findings have been very inconsistent. AIM The present study sought to retest the hypothesis that 2D:4D and sexual orientation are related is a manner consistent with neurohormonal theory. METHODS A 2D:4D measure (of the right hand) along with four additional somatic markers of androgen exposure (height, physical strength, muscularity, and athletic ability) with samples of college students in Malaysia (N = 2,058) and the United States (N = 2,511). The five androgen measures were factor analyzed, resulting in a two-factor solution: Factor 1 consisted of strength, muscularity, and athletic ability (the muscular coordination factor), and Factor 2 was comprised of the r2D:4D and adult height (the bone growth factor). MAIN OUTCOME MEASURES Sexual orientation was measured by asking each respondent the extent to which they were sexually attracted to males and the extent to which they were sexually attracted to females, both on 11-point scales. RESULTS When the countries and sexes were analyzed separately, neither the r2D:4D measure nor Factor 2 correlated with sexual orientation to significant degrees. Instead, it was the muscular coordination factor that correlated the best. Support was found for the hypothesis that prenatal androgens influence sexual orientation, but the nature of these influences was more complex than neurohormonal theory predicted. CONCLUSION A modified theory is needed and presented to accommodate the results from this study.
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Affiliation(s)
- Lee Ellis
- University of Malaya, Kuala Lumpur, Malaysia
| | - Amy Lykins
- University of New England, Armidale, NSW, Australia
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Hou WW, Tse MA, Lam TH, Leung GM, Schooling CM. Adolescent testosterone, muscle mass and glucose metabolism: evidence from the 'Children of 1997' birth cohort in Hong Kong. Diabet Med 2015; 32:505-12. [PMID: 25307068 DOI: 10.1111/dme.12602] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 01/19/2023]
Abstract
AIMS Diabetes rates are high in Asia despite relatively low rates of obesity, which might be related to lower muscle mass. Muscle mass plays an important role in glucose metabolism. Peak muscle mass is obtained in late adolescence. We tested the hypothesis that pubertal testosterone is negatively associated with glucose metabolism mediated by muscle mass. METHODS Participants aged 15 years (278 boys and 223 girls) were recruited from the Hong Kong's 'Children of 1997' birth cohort in 2012. Multivariable linear regression with multiple imputation and inverse probability weighting was used to examine the adjusted associations of pubertal testosterone with skeletal muscle index, body fat percentage, fasting glucose, insulin and homeostasis model of assessment - insulin resistance. RESULTS Total testosterone was negatively associated with fasting glucose (-0.008, 95% confidence interval -0.015 to -0.002), insulin (-0.43, 95% confidence interval -0.56 to -0.30) and insulin and homeostasis model of assessment - insulin resistance (-0.09, 95% confidence interval -0.12 to -0.06) adjusted for sex, birth weight, highest parental education, mother's place of birth and physical activity. These associations were attenuated by additional adjustment for skeletal mass index or body fat percentage. CONCLUSIONS Adolescent glucose metabolism may be influenced by testosterone, perhaps partially via skeletal muscle mass.
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Affiliation(s)
- W W Hou
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Cheung KKT, Luk AOY, So WY, Ma RCW, Kong APS, Chow FCC, Chan JCN. Testosterone level in men with type 2 diabetes mellitus and related metabolic effects: A review of current evidence. J Diabetes Investig 2014; 6:112-23. [PMID: 25802717 PMCID: PMC4364844 DOI: 10.1111/jdi.12288] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 12/20/2022] Open
Abstract
A significant proportion of patients with type 2 diabetes mellitus have a low testosterone level relative to reference ranges based on healthy young men. Only a small number of these patients suffer from classical hypogonadism as a result of recognizable hypothalamic-pituitary-gonadal axis pathology. The cut-off value of the serum testosterone level in men without obvious hypothalamic-pituitary-gonadal axis pathology is controversial. It is unclear to what extent a low serum testosterone level causally leads to type 2 diabetes and/or the metabolic syndrome. From a theoretical standpoint, there can be complex interactions among the hypothalamic-pituitary-gonadal axis, body composition and insulin resistance, which can be further influenced by intrinsic and extrinsic factors to give rise to metabolic syndrome, glucose intolerance, and low-grade inflammation to increase the risk of cardiovascular disease. Although a low serum testosterone level frequently coexists with cardiometabolic risk factors and might serve as a biomarker, more studies are required to clarify the causal, mediating or modifying roles of low serum testosterone level in the development of adverse clinical outcomes. Currently, there are insufficient randomized clinical trial data to evaluate the effects of testosterone replacement therapy on meaningful clinical outcomes. The risk-to-benefit ratio of testosterone therapy in high-risk subjects, such as those with type 2 diabetes, also requires elucidation. The present article aims to review the current evidence on low serum testosterone levels in patients with type 2 diabetes, and its implications on cardiovascular risk factors, metabolic syndrome and adverse clinical outcomes.
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Affiliation(s)
- Kitty Kit Ting Cheung
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Andrea On Yan Luk
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Wing Yee So
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Alice Pik Shan Kong
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Francis Chun Chung Chow
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Juliana Chung Ngor Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
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Wong IOL, Cowling BJ, Schooling CM. Vulnerability to diabetes in Chinese: an age-period-cohort analysis. Ann Epidemiol 2014; 25:34-9. [PMID: 25453351 DOI: 10.1016/j.annepidem.2014.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/29/2014] [Accepted: 10/10/2014] [Indexed: 01/19/2023]
Abstract
PURPOSE Hong Kong, in common with other Asian settings, has high rates of diabetes mellitus (DM) despite a relatively nonobese population. Given the rapid economic development in the region, most Asians grew up in limited living conditions. We examined the longitudinal mortality trends of DM. We assessed whether the first generation (birth cohorts in the 1930s) with late adolescence in a more economically developed environment had a lower risk of DM. METHODS We used DM deaths and population figures in Hong Kong, 1976 to 2010. We fitted age-period-cohort models to decompose mortality rates into effects for age at mortality, calendar period of mortality, and birth cohort. RESULTS The risk of death from DM fell for the first generation (births in the early 1930s) with late adolescence in Hong Kong, but possibly the risk rose again for the first generation (birth 1960s) affected by the obesity epidemic. CONCLUSIONS Adiposity might contribute to diabetes in Hong Kong, and similar Asian settings, however current vulnerability of many older Asians to DM in plentiful environments may be the result of limited living conditions until adulthood. Furthermore, our findings are more consistent with limited adolescent conditions than fetal undernutrition playing a role in vulnerability to DM.
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Affiliation(s)
- Irene O L Wong
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Benjamin J Cowling
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Catherine Mary Schooling
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China; CUNY School of Public Health and Hunter College, New York, NY.
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